Part IV. Agreements

Part IV. Agreements

Instructions: Part IV: Agreements is an evaluation of the annual planning meeting. It contains individual and team questions, as well as a signature page that is signed by all present at the meeting. Answer all questions and record any plans to address or resolve objections. This is also a place to record any inability to meet a request and the related team decision. If a service, support or resource is unavailable to achieve an outcome, the Support Coordinator contacts the Regional Community Resource Consultant to discuss.
Individual - Does my plan match…?
what makes me happy? / Yes No / what I need to be safe? / Yes No
my dreams? / Yes No / how I contribute? / Yes No
being with people that I like? / Yes No / new things I want to learn? / Yes No
where & how I want to live? / Yes No / my work dreams? / Yes No
things I like to do? / Yes No / the support that I need? / Yes No
how I want to travel? / Yes No / people who support me? / Yes No
how I want to handle my money? / Yes No / how I describe a good life? / Yes No
I have had the opportunity to plan for personal topics apart from the full team. / Yes No
I was supported to direct and participate in my planning process as described in My Planning Preferences in Part II. If no, explain below. / Yes No
If the answer is “no” to any of these questions, go back to that part of the profile and consider again. Please describe the reason for any questions above remaining “no” at the end of the meeting and any plan to resolve.
Team
Does any team member have an objection to any outcomes in my plan? / Yes No
Are there any restrictions that require review or agreement? / Yes No
Do I need financial planning or benefits counseling in order to maintain or maximize resources? / Yes No
Are there any IMPORTANT TO or IMPORTANT FOR information elsewhere (such as in the SIS or PCT TOOLS) that are not addressed in my plan? / Yes No
Please describe the reason for any questions above being marked “yes” and any plan to resolve.
Supports or resources needed to achieve desired outcomes are not available: Yes No
Note: If yes, the Support Coordinator contacts theCommunity Resource Consultant to discuss.
Signatures of partners who agree to help me with my plan:
Individual / Date
Support Coordinator / Date
Substitute Decision-Maker / Date
Partner / Relationship/service/support / Date
Partner / Relationship/service/support / Date
Partner / Relationship/service/support / Date
Partner / Relationship/service/support / Date
Partner / Relationship/service/support / Date
Partner / Relationship/service/support / Date
Names of partners who contributed to my plan and were not here for planning:
Quarterly review dates: 1- 2- 3- 4-
Comments:

This ISP belongs to: ID# _____ISP Start: End: ______Revision: ______

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